Saturday, January 30, 2010

Primary Amenorrhea In 32 Year Old



Question:

I am 32 years old and never had a period. My mom took me to the doctor when I was 20 yrs old and they did an ultrasound of my abdomen which showed no cysts in the ovaries and a hormone test which showed that my FSH and LH levels were low. The TSH was normal.

A genetics test confirmed that I am xx. I used the contraceptive pill and had a bleeding. I have always had excess hair growth since puberty and acne issues. Do you think something is seriously wrong with me or I should just let things stay the way they are?

Answer:

There is absolutely something wrong, and it should have been taken care of a long time ago. Without specific laboratory information I cannot tell you what the problem is, but you have some type of ovarian dysfunction. In other words, your ovaries are not working. The bad part of this is that you are probably estrogen deficient. Estrogen is the female hormone and is important for many different parts of your body. As a consequence, you have an elevation in the male hormone, testosterone, because your ovary is not making estrogen. If you keep up like this you could suffer the following consequences: increased facial and body hair, loss of head hair (male pattern baldness), increased acne, deepening of the voice, obesity, diabetes, osteoporosis, increased heart disease.

The reason for the birth control pill was to give you the female hormones that you need and block the male hormone production. If you are not planning on getting pregnant, then you need to go back on the birth control pill. I would recommend that you go on Yasmin or Yaz, which blocks the male hormone better. Bottom line is that you need to see an Endocrinologist or Reproductive endocrinologist.

Good luck and be sure to follow through with my advice!

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

4 comments:

  1. duphaston helps me a lot in treating my ammenorrhea. i purchased it from www.medsheaven .com and i fell good.

    ReplyDelete
  2. Hi. Just for other's reader's sake, Duphaston is a progesterone. It treats amneorrhea (lack of menses) by inducing a withdrawal bleed. It works the same as other progesterones such as Provera, Prometrium, Endometrium and others. Women with a uterus, who do not have regular periods need to have a period at least every three months. The lack of a period means there is some type of hormonal dysfunction going on. Going a long time without periods can cause problems like very very heavy bleeding (menorrhagia) that can be life threatening hemorrhage, endometrial hyperplasia (a precancerous condition in some cases) or endometrial cancer. If you are trying for pregnancy, progesterone does not make you fertile. In fact, the problem is probably that you are not ovulating and so do not have a period. In that case, you need a fertility drug to get your ovaries to ovulate regularly.

    Progesterone induces the period by causing the uterine lining to shed. It does nothing to correct the hormonal disorder or to get the ovary to ovulate.

    ReplyDelete
  3. Hi I have similar problem as the above reader. I do have one time period of very dark brown menses for 2 days and thereafter I don't have period at all. I am currently 30 and is taking Yasmin for periods. Blood test has shown my fsh level is high. I am intending to have kids but this is very devasting. My doctor seems to be no help at all. I need your advice if there is any drugs I can take to induce normal period or have a kid eventually ?

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  4. Hello Shirleydreamy,

    Sorry for the delay in getting back to you. Your email got lost in a "pile" of emails and the holidays.

    Yasmin is a very low dose birth control pill and like other low dose birth control pills, the amount of estrogen is low so that there is not much endometrial lining development. The amount of bleeding with a period is directly related to the thickness of the lining. If the lining is thin, as with low dose pills, there will be very little bleeding if any at all. That would explain the small amount of brown (old blood) bleeding that you have.

    In order to interpret your FSH level for you, you would have to share the level. I am not sure what you mean by "high". If the level is above 20, that is an indication that the ovaries have shut down or are in the process of shutting down. In general, from an infertility point of view, we like the estradiol to be at 7 or below. Keep in mind that this test is only valid if it is done after a natural cycle and not a cycle on birth control pills.

    If the FSH level is between 10-20, we consider that to be "high" and indicates that the ovaries will not respond well to stimulation with fertility drugs in IVF. That is ALL it means. It does not mean that you cannot get pregnant. Because of this elevated FSH level, we do urge patients to try for pregnancy as soon as possible, and to consider the most aggressive and surest means to become pregnant. Time becomes a critical factor since we cannot predict when it will go above 20, meaning that the ovaries will shut down.

    I think that it is imperative that you see a fertility specialist as soon as possible if you are wanting to get pregnant so that you can get on a good treatment plan and achieve pregnancy quickly. I would not try anything on your own at this point.

    I hope this helps.

    ReplyDelete

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